Abstract

People are increasingly looking for health-related information and support to empower their self-management and decision making. Online health communities have not only become an important alternative source of patient-centered information but also appear to serve an emotional support role in connecting patients who have similar medical conditions. Trust is critical to sustain their continuous use and enhance their involvement. This is because each community member is typically identified only by a pseudonym, important personal information is often revealed, the quality of information provided by others varies, and the consequences of acting on incorrect advice can be severe. Using semi-structured interviews and data from postings, this study qualitatively explores the trust development between users of forum-based online health communities. Based on data from a wide range of medical conditions, we formulated a three-process framework for establishing trust that conceptualizes how users build trust through the text-based medium and how they progress from one process to another. We contribute to theory by extending existing variance theories in trust to a hybrid process theory which explains the dynamic progression from one state to another. It suggests several design foci that can enhance user experience of these forums.